Related Experiment Video
Updated: May 23, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Postprocedural Anticoagulation After Primary Percutaneous Coronary Intervention: 1-Year Results From the RIGHT Trial
Yan Yan1, Xiao Wang2, Zeyuan Fan3
1Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China; National Clinical Research Center of Cardiovascular Diseases, Beijing, China; Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Beijing, China.
Insights
Postprocedural anticoagulation (PPA) after primary PCI in STEMI patients was safe but did not reduce major adverse cardiac events (MACEs) at 1 year. Enoxaparin may offer benefits, warranting further investigation.
Area of Science:
- Cardiology
- Interventional Cardiology
- Pharmacology
Background:
- The RIGHT trial evaluated postprocedural anticoagulation (PPA) efficacy and safety in ST-segment elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI).
- Assessing 1-year outcomes was a primary objective.
Purpose of the Study:
- To report the prespecified 1-year outcomes of the RIGHT trial.
- To evaluate the efficacy and safety of low-dose PPA compared to placebo in STEMI patients post-PCI.
Main Methods:
- A multicenter, randomized, double-blind, placebo-controlled superiority trial (RIGHT) involving 53 sites in China.
- STEMI patients were randomized post-PCI to receive low-dose PPA (enoxaparin, unfractionated heparin, or bivalirudin) or placebo for at least 48 hours.
- Major adverse cardiac events (MACEs) and major bleeding were assessed over 1-year follow-up.
Main Results:
- No significant difference in MACEs between the PPA group (4.2%) and placebo group (4.9%) at 1 year (HR: 0.86; 95% CI: 0.61-1.21).
- Major bleeding rates were similar between groups (1.3% vs 1.5%; HR: 0.87; 95% CI: 0.47-1.62).
- Enoxaparin showed a reduction in MACEs compared to placebo (HR: 0.53; 95% CI: 0.30-0.97) with no excess bleeding; meta-analyses supported enoxaparin's benefit at 30 days.
Conclusions:
- Low-dose PPA following primary PCI in STEMI patients is safe but does not reduce ischemic events at 1 year.
- Enoxaparin may be beneficial for reducing MACEs in this population, suggesting a potential role when clinically indicated.
- Further studies are warranted to confirm the benefits of enoxaparin in STEMI patients post-PCI.
Background:
The RIGHT trial was designed to assess the efficacy and safety of postprocedural anticoagulation (PPA) in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (PCI).
Objectives:
The authors aimed to report the prespecified 1-year outcomes.
Methods:
RIGHT is an investigator-initiated, multicenter, randomized, double-blind, placebo-controlled, superiority trial conducted in 53 sites across China. Patients with ST-segment elevation myocardial infarction were randomly assigned (1:1) after primary PCI to receive low-dose PPA (enoxaparin, unfractionated heparin, or bivalirudin) or matching placebo for at least 48 hours. Major adverse cardiac events (MACEs) including all-cause death, nonfatal myocardial infarction, nonfatal stroke, stent thrombosis (definite), and urgent revascularization (any vessel), were assessed during a 1-year follow-up.
Results:
Over a median follow-up of 1.0 year (IQR: 1.0-1.0), MACE data were available for 99.2% of participants. MACEs occurred in 4.2% (63/1,494) of the PPA group and 4.9% (73/1,495) of the placebo group (HR: 0.86; 95% CI: 0.61-1.21), with no between-group difference in major bleeding (1.3% vs 1.5%; HR: 0.87; 95% CI: 0.47-1.62). In the group of enoxaparin vs placebo, we observed reduction of MACEs with enoxaparin (HR: 0.53; 95% CI: 0.30-0.97) with no excess bleeding. Meta-analyses also showed an advantage of enoxaparin over no anticoagulation in reducing MACEs at 30 days (risk ratio: 0.635; 95% CI: 0.399-0.997).
Conclusions:
Low-dose PPA after primary PCI was safe but did not reduce ischemic events at the 1-year follow-up. If clinically indicated, our results suggest that enoxaparin may be beneficial and warrants confirmation in future studies. (Comparison of Anticoagulation Prolongation vs. no Anticoagulation in STEMI Patients After Primary PCI [RIGHT]; NCT03664180).
Related Concept Videos
01:21Cardiac Catheterization II: Right Heart Catheterization
01:27Coronary Artery Disease V: Interprofessional Care
01:29Venous Thrombosis III: Interprofessional Care
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
01:28Cardiac Catheterization I: Pre-Procedure Overview
01:28Acute Coronary Syndrome IV: Interprofessional Care